Design and Development of 'Building Opportunities for Optimal physical activity Skills Training in children with Down Syndrome (BOOST-DS)' Programme and its Content Validation through Consensus using Modified Delphi method.
V Megha Jain, Bhamini K Rao, Selvam Ramachandran
Fifty-three of 62 play-based physical activity items for children with Down syndrome reached expert consensus across six motor domains.
The programme targets Indian special schools with minimal resources. No children have used it yet and no outcomes have been measured.
Key findings
1Of 62 active play items generated for children with Down syndrome, 53 achieved expert consensus (at least 80% of experts rating 4 or 5 on a 5-point scale) across strength, endurance, coordination, balance, agility and flexibility after three Delphi rounds. Nine items were rejected, mainly for safety concerns about jumping and hopping given joint hypermobility, or for instructions too complex for children with mild to moderate intellectual disability.
2The programme was designed around SAAFE teaching principles (supportive, active, autonomous, fair, enjoyable) integrated with participation constructs, targeting special school settings in India where resources are limited.
3The authors state the study established content validity only, and call for future feasibility and effectiveness studies (including a mixed-methods feasibility study, an A-B-A-B design, and longitudinal tracking) before the programme can be considered an effective intervention.
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What it does not show
No children with Down syndrome were involved in designing, validating or testing the programme. All 53 items reflect expert opinion only. The programme has not been piloted, so its feasibility, acceptability and effect on motor skills are unknown. The expert panel was small (11 people) and drawn from a single professional group (paediatric physiotherapy). No physical educators, parents, teachers or children contributed to the design. The study was a self-funded postgraduate dissertation with a tight timeline, which the authors say limited the depth of stakeholder engagement. The items were generated and validated in an Indian special school context. Whether they transfer to other settings or countries is untested. The paper reports different domain counts in the results section (balance 12, agility 12) versus the discussion (balance 10, agility 14), making it unclear which breakdown is correct.
Declared interests
The authors declare no conflicts of interest and no external funding. The work was a self-funded postgraduate dissertation.
The easy way to misread this
Do not read the 53-item list as evidence that this programme improves motor skills, participation or health in children with Down syndrome. It is a content-validated activity menu rated by 11 experts. No child has used it, no outcome has been measured, and the authors themselves call for feasibility and effectiveness trials before implementation.
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